<form method="post" action="https://secure.payza.com/checkout/PayProcess.aspx">
<input type="hidden" name="ap_purchasetype" value="subscription">
<input type="hidden" name="ap_merchant" value="[merchant_id]">
<input type="hidden" name="ap_itemname" value="[item_name]">
<input type="hidden" name="ap_currency" value="USD">
<input type="hidden" name="apc_1" value="[user_id]">
<input type="hidden" name="apc_2" value="[item_number]">
<input type="hidden" name="ap_quantity" value="1">
<input type="hidden" name="ap_description" value="[sitename] - [item_name]">
<input type="hidden" name="ap_amount" value="[amount]">
<input type="hidden" name="ap_timeunit" value="[unit]">
<input type="hidden" name="ap_periodlength" value="[period]">
<input type="hidden" name="ap_trialtimeunit" value="[trial_unit]">
<input type="hidden" name="ap_trialperiodlength" value="[trial_period]">
<input type="hidden" name="ap_trialamount" value="[trial_amount]">
<input type="hidden" name="ap_alerturl" value="[notify]">
<input type="hidden" name="ap_returnurl" value="[return]">
<input type="hidden" name="ap_cancelurl" value="[cancel]">
<input type="image" src="[merchant_button]" alt="Subscribe using Payza">
</form>